I have provided details of my experiences before on a similar thread and have repeated it here in case you find anything helpful towards your research. I'm more than willing to become more specifically involved if you wish...
In my experience I have found that general wards are not suitable for dementia patients who are mobile. They are already confused about the unfamiliar surroundings and this, coupled very often with sundowning and the need to get "home", means that they will abscond off the ward. My mother got off her ward regularly - was found outside at 2am, set off the fire alarm in the middle of the night as she went out the fire exit 3 floors up, and one evening made it outside and on to a bus! To be fair to the staff, particularly on an acute ward, they are not resourced to give the dementia patient the time that they need in order to settle them. It is one thing to understand and have the knowledge about dementia, it is another thing entirely having the time to apply them.
It is not just the staff that are challenged by dementia patients, other patients and their relatives are too. When my mother was in hospital for a prolonged period of time relatives made formal complaints about her - for what reason - for her speaking during visiting times!!! She wasn't aggressive - just a friendly chatty lady with dementia! During the night her restlessness and talking and shouting out made it difficult for other patients in her ward. So perhaps one aspect to be considered might be placing the dementia patient in an area where there is least disruption perhaps? Single room perhaps? Relatives asked to bring in some things that might be familiar to them? One thing they shouldn't do in my experience is put them in a ward on their own with an unconcious patient - thinking that the patient wouldn't be disturbed ! They did this to my mother and she thought she was being forced to sit with her mother who was dying and was distraught by this. The staff however paid no heed - think they thought they had a temporary "fix" on their hands.
My overall view of what should happen is that the dementia patient is best served in the elderly mentally infirm ward, or similar, if you have such a ward in your hospital. These wards and staff are set up and staffed to deal with the patient quite frankly. They are normally secure wards and are more tolerant of such things as walking around during the night, wanting to go "home", just wanting company and a chat. I know that this would probably mean them having to be transferred to another consultant but in terms of smooth running of the hospital, would this not be the preferred thing to do for all concerned?
To my mind what is apalling is to try and manage the dementia patient by use of a chemical cosh! We all know that it happens and to my mind it is wrong wrong wrong! And whilst i'm on my high horse, the staff on the ward need to communicate with relatives of the person with dementia - of all things that I could advocate this would be the number one thing you should insist on. As much as they might have medical knowledge I can almost guarantee you that they have no knowledge about the needs and the challenges of the individual and how to deal with them. Sometimes the arrogance of the staff is what frustrates relatives and lack of communication, particularly hiding behind such excuses as data protection and patient confidentiality, particuarly when it is clear that the dementia patient cannot in any way speak for themselves, is something which they really need to address. Relatives are more than willing to help, to share information, heck we'll even come and sit through the night with them if it is that bad (we did this more than once when the staff couldn't cope and had had an influx of urgent cases) - we do afterall have the best interests of our relatives at heart.
I do appreciate all the work that nurses and doctors do and I don't blame them with all the stresses and demands of the other patients on general wards, if they find that they don't have the time to give the dementia sufferer all the individual attention that they need. Maybe it needs to be addressed in another way perhaps. Maybe dementia becomes the primary illness every time and a suitable ward is found based on this and not perhaps the other "illnesses" that they are presenting with? I will be interested to hear what the outcome of your study is - that is if you feel you will be able to share some of it with us here on TP. I do hope so.
Fiona
